09 de novembre 2017

Uncertainty and regret in medicine

The Power of Regret

While reading NEJM I find an article on regret:
As physicians, we are acutely aware of the element of uncertainty in medicine, but we less often recognize its close companion, regret. Regret in all its forms can be a powerful undercurrent, moving patients to act in ways that may baffle us.
Kahneman and Tversky said  that bad outcomes from recent action are more regretted than similar outcomes from inertia. There two types of bias that affect regret. Omission bias is the tendency toward inaction or inertia — reflects anticipated regret. Commission bias is the tendency to believe that action is better than inaction, and can result in regret arriving later when a bad outcome occurs.
When we’re in pain or acutely anxious, we are “hot” and apt to make choices that we imagine will rapidly remedy our condition, which predisposes us to commission bias. In a hot state, patients may discount too deeply the risks posed by a treatment and overestimate its likelihood for success, paving the way for later regret if the outcome is poor. Patients who choose elective procedures while in a hot
state and end up with a bad outcome may be at particular risk for regret due to commission bias.
Georges Seurat. Two Sailboats at Grandcamp (Deux voiliers à Grandcamp), c. 1885.
Oil on panel, BF1153. Public Domain. Barnes Foundation